BILL NUMBER: AB 1606	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 22, 2010
	AMENDED IN ASSEMBLY  MARCH 23, 2010

INTRODUCED BY   Assembly Member Coto

                        JANUARY 6, 2010

   An act to add Section 14132.07 to the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1606, as amended, Coto. Medi-Cal: department-approved chronic
disease self-management programs.
   Existing law establishes the Medi-Cal program, administered by the
State Department of Health Care Services, under which basic health
care services are provided to qualified low-income persons. The
Medi-Cal program is, in part, governed and funded by federal Medicaid
provisions. 
   Existing law requires the department to submit an application to
the federal Centers for Medicare and Medicaid Services (CMS) for a
waiver or demonstration project that would implement specified
objectives. Existing law requires the waiver or demonstration project
to include designated restructuring proposals for the organization
and delivery of services under the Medi-Cal program. Existing law
provides that the restructuring proposals may include, but are not
limited to, better care coordination for, among other persons,
seniors and persons with disabilities, and requires better care
coordination to include the establishment of organized delivery
systems that incorporate a medical home system of care and disease
management. 
   This bill would require the department  to seek, and if
obtained, to implement, all federal waivers necessary to allow for
the services provided through a department-approved chronic disease
self-management program, as defined, to be reimbursable under the
Medi-Cal program   to include reimbursement under the
Medi-Cal program for services provided through a department-approved
chronic disease self-management program, as defined, as part of the
above-described restructuring proposals. The bill would provide that
if the department includes better care coordination as part of the
above-described restructuring proposals, reimbursement for services
provided through a department-approv   ed chronic disease
self-management program be implemented as part of the department's
implementation of better care coordination  .
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 14132.07 is added to the Welfare and
Institutions Code, to read:
   14132.07.  (a)  (1)    For purposes of this
section, a "department-approved chronic disease self-management
program" means a chronic disease self-management program approved by
the department that has been tested through randomized controlled
trials and satisfies the following conditions: 
   (1) 
    (A)  Has been shown to be effective at improving or
maintaining the health status of people  who are over 18 years of
age  with chronic disease. 
   (2) 
    (B)  Has been shown to be suitable for implementation,
including implementation through community-based services
organizations, and is ready for broad national distribution through
those organizations. 
   (3) Nonclinical workers or volunteers are utilized in the delivery
of the services provided by the chronic disease self-management
program.  
   (4) 
    (C)  Any results from the randomized controlled trials
done on the chronic disease self-management program have been
published in a peer-reviewed scientific journal. 
   (b) (1) The department shall seek approval for, and if obtained,
implement, all federal waivers necessary to allow the services
provided to Medi-Cal beneficiaries through a department-approved
chronic disease self-management program to be reimbursable under the
Medi-Cal program.  
   (2) In implementing paragraph (1), the department shall consider
including reimbursement for services provided through
department-approved chronic disease self-management programs as part
of the waiver under Section 1115 of the federal Social Security Act
(42 U.S.C. Sec. 1315) to replace the current Medi-Cal
Hospital/Uninsured Care Demonstration Project or as part of the
waiver for the Multipurpose Senior Services Program, or both.
 
   (D) Courses provided through the chronic disease self-management
program are affiliated with a licensed Medi-Cal provider that will
assume responsibility for billing, monitoring quality of service, and
ensuring cultural competency.  
   (2) Nonclinical workers or volunteers may be used in the delivery
of services provided under a department-approved chronic disease
self-management program.  
   (3) Services provided by a department-approved chronic disease
self-management program may be provided through the Internet.
Internet delivery of department-approved chronic disease
self-management program services is particularly appropriate for
homebound and disabled individuals.  
   (b) (1) The department shall include reimbursement under the
Medi-Cal program for services provided through a department-approved
chronic disease self-management program as part of the restructuring
proposal described in subdivision (b) of Section 14180.  
   (2) If the department includes better care coordination, as
described in paragraph (1) of subdivision (b) of Section 14180, as
part of the restructuring proposal required by subdivision (b) of
Section 14180, the department shall implement paragraph (1) as part
of its implementation of paragraph (1) of subdivision (b) of Section
14180.